Cubital tunnel syndrome is a condition that affects the ulnar nerve where it crosses the inside edge of the elbow. The symptoms are very similar to the pain resulting from a person hitting his or her funny bone, which is actually the ulnar nerve being hit on the inside of the elbow. There, the ulnar nerve runs through a passage known as the cubital tunnel. When this area becomes irritated such as from injury or pressure, it can lead to cubital tunnel syndrome.
The ulnar nerve actually starts at the side of the neck, where the individual nerve roots leave the spine. The nerve roots exit through small openings between the vertebrae, known as foramen. The nerve roots join together to form three main nerves that travel down the arm to the hand. One of these nerves is the ulnar nerve. The ulnar nerve passes through the cubital tunnel just behind the inside edge of the elbow. The tunnel is formed by muscle, ligament, and bone. The ulnar nerve passes through the cubital tunnel and winds its way down the forearm and into the hand. It supplies feeling to the little finger and half the ring finger and controls the small muscles of the hand.
Because of the importance of hand function in most activities of daily living, the ulnar nerve, which provides the predominant motor innervation to the hand, is perhaps the single most important somatic peripheral nerve in the body. Neuropathy of the ulnar nerve can result in significant disability due to loss of hand function from pain, numbness, and weakness. The most common causes of ulnar nerve neuropathy are entrapment, impingement, stretching, and friction at or around the vicinity of the elbow. Because of the multiplicity of pathological processes that can lead to ulnar neuropathy at the elbow, reviewing its causes and treatment as reported in the medical literature can be confusing and misleading. An example of the diversity of perspectives is the variety of names given throughout the last several decades to describe the phenomenon of ulnar neuropathy at the elbow. This disease process has been referred to as tardy ulnar palsy, traumatic ulnar neuritis, compression neuritis of the ulnar nerve, Feindel-Osborne syndrome, and cubital tunnel syndrome. Tardy ulnar palsy refers only to patients who develop a slow, chronic deterioration of ulnar nerve function months to years after trauma to the elbow. The term cubital tunnel syndrome oversimplifies the ulnar neuropathy at the elbow, which can be due to a number of factors other than compression within the cubital tunnel, such as for example recurrent subluxation of the ulnar nerve out of its groove, or entrapment proximal or distal to the cubital tunnel. The term cubital tunnel syndrome in its broadest sense is a focal neuropathy involving the ulnar nerve in the vicinity of the cubital tunnel.
If modification of habit and/or use of special splints do not relieve the pain caused by the neuropathy, then surgery can be needed to release the nerve. Traditionally, nerve releases have been performed utilizing a long incision on the medial side of the elbow leaving a long scar, usually with some damage to the cutaneous nerves around the elbow and associated morbidity. On the average, a three to four day stay in the hospital was expected. Recently, endoscopic techniques using smaller incisions and requiring less healing time have been developed with varying degrees of success.